The “One Big Beautiful Bill” and Its Impact on Hospitals & Patients

In July 2025, Congress passed the One Big Beautiful Bill (OBBB), sweeping legislation that reshapes healthcare funding in the U.S. While the bill aims to control federal spending, its implications for hospitals, billing departments, and patients are significant.

With billions of dollars in Medicaid cuts and new rules for states and patients, health systems now face growing financial pressures while patients are bracing for higher out-of-pocket costs. Let’s break down the major changes and what they mean for both sides of the equation.

Key Provisions of OBBB

Several components of the OBBB will directly affect how hospitals deliver care and manage their revenue cycles:

1. Medicaid Cuts and Coverage Loss: The bill reduces Medicaid and CHIP spending by an estimated $1 trillion over 10 years¹. Analysts project that nearly 12 million Americans will lose health insurance by 2034².
2. Uncompensated Care: Hospitals could face an additional $63 billion in costs, with total uncompensated care expected to rise by $204 billion nationwide³.
3. Provider Tax Caps: Many states use provider taxes to increase federal match funding. The bill limits this option, shrinking state flexibility and reducing supplemental payments that hospitals rely on⁴. 
   
4. Patient Requirements: New work requirements (e.g., 80 hours per month for some adults) and higher cost-sharing for certain ER visits may push more people out of Medicaid⁵. 
5. Offset Funds: A $50 billion rural hospital fund was included as partial relief, but experts argue it falls short of offsetting nationwide coverage losses⁶. 

What This Means for Hospitals & Billing Teams

For hospitals and health systems, the OBBB isn't just a policy shift, it's a financial turning point. Hospitals are already operating on tight margins, and the bill is expected to intensify that strain.

• More bad debt and uncompensated care: Millions of Americans are expected to lose Medicaid coverage, pushing more families into the uninsured category. The rise in self-pay accounts means more unpaid balances and increased risk of bad debt. 
• Cash flow pressure: Lower reimbursement rates and reduced supplemental payments will squeeze operating budgets. Billing teams may be forced to accelerate patient collections just to keep pace. 
• Increased complexity and staff burden: With new eligibility rules and cost-sharing requirements, patients will have more billing questions and disputes. Billing staff will be fielding higher call volumes, more appeals, and greater administrative work. 
• Need for automation: Manual processes won't scale with the increased demand

What This Means for Patients

For patients, the new legislation translates to higher financial responsibility and, in many cases, fewer coverage options:

• Coverage losses: Millions are expected to lose Medicaid coverage, pushing more families into the uninsured category².
• Higher out-of-pocket bills: Patients who remain covered may face new cost-sharing requirements for ER visits and other services, making healthcare less affordable⁵.
• Billing confusion and frustration: Eligibility changes and new payment rules add complexity. Patients may be surprised by bills they thought would be covered, damaging their trust in providers. 
• Access concerns: As hospitals struggle financially, some may reduce services or close, especially in rural areas. This forces patients to travel farther and delay care, leading to worse health outcomes⁷.

How Hospitals Can Respond

The challenges introduced by the One Big Beautiful Bill are steep, but proactive health systems can take steps to protect both patient trust and financial stability.

Hospitals can strengthen financial counseling by helping patients understand coverage and financial options before care is delivered. This proactive communication builds trust and reduces the likelihood of surprise bills⁸. Additionally, they can also prioritize cost transparency by providing clear and accurate cost estimates upfront. Transparent pricing improves patient satisfaction and helps prevent disputes after care⁹.

Offering flexible payment options can ease the burden of rising out-of-pocket costs. Digital-first payment plans can improve collections while making it easier for patients to manage their medical bills¹⁰.

Finally, automating billing workflows can reduce administrative strain, speed up collections, and allow staff to focus on higher-value patient engagement activities¹¹. This kind of operational efficiency is becoming essential as hospitals face tighter margins and increased billing complexity.

How BridgeMed Can Help

At BridgeMed, we understand that hospitals are facing a perfect storm of shrinking reimbursements, rising uncompensated care, and growing patient dissatisfaction. That's why our solutions are designed to protect both cash flow and patient experience:

• Accurate patient estimates and eligibility checks: Our platform verifies coverage in real time and generates precise estimates, helping patients avoid surprise bills and improving their likelihood of payment. 
• Flexible, patient-centered payment plans: BridgeMed offers digital-first, no-interest payment options that make it easier for patients to manage their bills while increasing collections for providers. 
• Automation and analytics: By streamlining billing workflows and providing predictive insights, BridgeMed helps hospitals detect cash flow risks early and respond quickly. 
• Support during coverage transitions: With personalized communication strategies, we help patients navigate coverage changes, reducing confusion and maintaining trust in their provider. 

The One Big Beautiful Bill will reshape healthcare finance over the next decade. Hospitals and patients alike face new challenges, from mounting uncompensated care to higher out-of-pocket costs. But with the right strategies–transparency, automation, and patient-centered payment solutions–health systems can weather these changes while preserving trust and stability. BridgeMed is here to help health providers safeguard cash flow and patient satisfaction in this new era. Connect with us today to learn how we can support your billing department and your patients.